Population growth: Strategy for 7th Plan raises questions

THE PROPSALS that the Population Welfare Division has submitted for the Seventh Five-Year Plan make incongruous reading.

The first 45 pages are a candid admission of failure: the government could not meet any of the population targets of the Sixth Plan. Yet the goals spelt out for the Seventh Plan are even more ambitious than the previous ones which proved unattainable,

In the Sixth Plan period, not much headway has been made in the demographic sector. The Plan had aimed at increasing the level of acceptors from 9.5 per cent in 1983 to 18.6 per cent in 1988. But according to the Population Division’s report family planning practice actually fell to 9.15 per cent in 1987.

Birthrate

The crude birth rate was to be brought down from the 1983 benchmark of 40.3 per 1000 to 36.2 per 1000. It was reduced to 37 per 1000 in 1987.

The total fertility rate was to be scaled down from 5.9 in 1983 to 5.4 in 1988. It stood at 5.8 in 1987.

As a result, the objective of reducing the population growth rate from 2.8 per cent in 1983 to 2.6 per cent in 1988 has proved elusive. It is estimated that the population growth rate will be 2.7 per cent at the end of the Sixth Plan period.

As could be anticipated, the physical targets of the Sixth Plan are not expected to be fulfilled either. The point to be emphasized is that results have not been achieved in spite of the large sums that have been spent.

Of the amount earmarked in the Sixth Plan — Rs 2300 million — over Rs 2249 million was allocated and 93 per cent utilised And yet the planned number of Family Welfare Ccentres and Contraceptive Distribution Points could not be established.

Nor were the Target Group institutions, Hakim Matabs, Provincial Line Departments and NGOs mobilized sufficiently to serve as outlets for the population programme.

The Population Division has identified the major factors which are responsible for the failure of the programme. These are:

lack of strong political and administrative commitment need for greater decentralisation of the programme

absence of adequate field supervision, monitoring and evaluation at all levels,

ineffective use of outreach facilities

incorrect location of Family Welfare Centres, poor quality of services, insufficient involvement of the traditional birth attendants and private medical practitioners in the programme

too much reliance on foreign funding and

complex procedures for financial and personnel resource allocation

Strategy Shift

Keeping in view the failures of the Sixth Plan, the Population Division has proposed shift in strategy in the Seventh Five-Year Plan. After the traditional reaffirmation of the broader aim of the population policy, namely, the improvement of standard of living and quality of life of the people by facilitating socio-economic and human development, the Population Division goes on to formulate its future strategy.

First, it suggests greater cooperation between different government departments and lays great emphasis on the role of the Federal Health Ministry in reducing morbidity and mortality among infants and children — the key factor in determining population growth rate. An integrated approach is important for the success of the population programme, but in the absence of the required political will it is not clear how this cooperation is to be elicited.

Secondly, there is to be greater emphasis on clinical methods such as contraceptive surgery, IUD insertion and injectables.

Questionable wisdom

The wisdom of this strategy can be seriously questioned, according to experts.

A pronounced shift to clinical methods which are characteristically female-oriented will increase the cost of the programme. It will also limit its accessibility by making the programme more dependent on health workers and medical personnel. Moreover its appeal in a male-dominated society will be restricted, the experts pointed out.

The health hazards some of these contraceptives pose for women cannot be ignored either. The medical profession is no longer agreed on how safe are injectables and IUDs. As for oral pills, it is now universally recognised that they should not be used without medical supervision, they said.

It is regrettable that the Seventh Five-Year Plan should aim at changing totally the ratio of acceptors using different contraceptives. The percentage of acceptors using condoms, which are regarded to be the safest birth control device, will be reduced from 40 per cent to 21 while those on injectables will go up from 6.7 per cent to 12.4 and IUDs from 28 to 37 per cent.

This also points to a basic weakness in the government’s population policy: its failure to enlist sufficient male participation by strengthening the information, education and communication sector and directing it towards men.

Thirdly, health outlets, especially in the rural areas will be used to improve the coverage of the population.

Incentives

In this regard, theoretically speaking, it should be a sound idea to involve the rural health centres and the basic health units in the task of spreading the small family norm. But much would depend on the degree of cooperation extended by the health departments since the rural health facilities fall in their jurisdiction.

Fourthly, supervision will be made more effective.

Fifthly, mobile and out-reach teams will be strengthened.

Sixthly, incentives and disincentive schemes will be introduced. The monetary incentives suggested are ‘no birth bonus’ from employers and special concessions as low interest loans for housing and agriculture for couples with only two or three children.

These might not be easy to implement in practice and could open the door to corruption on a large scale. In addition, the existing outlets are to be improved and expanded and the information education and communication component is to be strengthened. Although the Population Division recognises the weaknesses and constraints in its population policy it has nevertheless ventured to lay down ambitious demographic target.

Beyond reach

They could, however, prove to be beyond its reach. For instance, it speaks of reducing the crude rate from 37 to 25 per 1000, the population growth rate from 2.7 to 1.6 per cent, the total fertility rate from 5.7 to 5 by 1993. Thus the programme hopes to avert 5.4 milion births in the Plan period.

The entire programme is expected to cost Rs 4165 million which is nearly double of what was spent under the Fifth Plan.

It has not been indicated what the foreign aid component of the population programme is estimated to be.

The lack of political commitment to the population programme is clearly underlined by the government’s unwillingness to fund the population projects from its own resources.

The Population Division admits that “in absolute terms the yearwise Government of Pakistan contribution has shown a steady increase yet in relation to foreign assistance, it has shown a significant decline.”

In the last two years of the Sixth Plan, the foreign aid component had risen phenomenally and 72 per cent of the population budget was financed by foreign donors. The foreign aid ratio was 53 per cent in 1984-85.